[A comparative study of endoscopic and traditional open surgery in the treatment of papillary thyroid carcinoma].

Objective: To evaluate the feasibility, safety and efficacy of endoscopic thyroidectomy in the treatment of papillary thyroid carcinoma through clinical follow-up. Methods: Patients who underwent total thyroidectomy and had a final pathologic diagnosis of papillary thyroid carcinoma at Department of Thyroid Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine between February 2013 and April 2014 were enrolled in this study; those who had family history of thyroid cancer or a history of radiation of the neck area were excluded. There were 78 male and 228 female pantients, aging from 20 to 77 years with an age of (45.6±12.7) years. The patients were then divided into two groups: endoscopic surgery group (n=48) and traditional open surgery group (n=258). The clinical and pathological features and long-term follow-up data were collected and analyzed. The differences in surgical trauma, completeness, postoperative complications, and recurrence and metastasis risks between the two groups were compared by t test, rank-sum test, χ(2) test or Fisher exact test. Results: Compared to open surgery, endoscopic thyroidectomy had significant longer surgical time ((3.2±0.6) hours vs. (1.6±0.5) hours, t=17.904, P=0.000), two cases converted to open surgery because of tumor invasion of the recurrent laryngeal nerve, and one because of a false negative cell biology preopertively. The two groups showed no significant difference in surgical trauma which was measured by bleeding, white blood cell, C reactive protein, drainage, and et al. During follow up, the two groups had no significant difference in rate of Tg<1 μg/L (97.9% vs. 91.9%, P=0.220). Recurrent rate showed no significant difference (4.1% in endoscopic group vs. 3.1% in open group, P=0.665) between the two groups after follow-up of (40.8±4.7) months. Recurrent time were either not significantly different ((23.5±21.9) months vs. (20.0±14.6) months, P=0.785) between the two groups. Conclusion: Compared with conventional open thyroidecomy, endoscopic thyroidectomy has the same safety, surgical completeness and long-term therapeutic effect.目的：探讨腔镜和开放甲状腺全切除术治疗乳头状甲状腺癌的可行性、安全性及有效性。 方法：回顾性分析2013年2月至2014年4月在浙江大学医学院附属第二医院甲状腺外科行甲状腺全切除术且术后病理确诊为乳头状甲状腺癌的初治患者资料，男性78例，女性228例；年龄(45.6±12.7)岁。按照手术方式分为腔镜组48例及开放组258例。记录临床病理学信息及随访结果。采用t检验、秩和检验、χ(2)检验和Fisher精确概率检验比较两组的手术创伤、根治性、术后并发症及复发转移风险。 结果：相较于开放组，腔镜组手术时间较长[(3.2±0.6)h比(1.6±0.5)h，t＝17.904，P＝0.000]，2例因喉返神经受侵，1例因术前考虑良性术中冰冻恶性、肿瘤较大中转开放。术后机体炎症指标、引流量及住院时间等两组差异无统计学意义。术后促甲状腺素非抑制状态下，甲状腺球蛋白<1 μg/L的患者比例腔镜组与开放组相当(97.9%比91.9%，P＝0.220)。随访(40.8±4.7)个月，两组复发率(4.1%比3.1%，P＝0.665)及术后复发时间[(23.5±21.9)个月比(20.0±14.6)个月，P＝0.785]差异无统计学意义。 结论：腔镜与开放甲状腺全切除术的手术安全性、根治性及远期治疗效果相似。.